Scientist believe influenza, commonly called, seasonal flu, originated in birds many years ago and slowly mutated to human flu. So avian influenza or bird flu has always been around but there is a new type of extreme concern which is the one caused by the H5N1 virus. This new strain of the virus is highly contagious and spreads rapidly through affected flocks killing 50 to 100% of animals, often within 48 hours.

Poultry outbreaks caused by avian influenza virus A/H5N1 have not been reported in Nepal. However outbreaks in neighbouring India and China have alerted the government, UN agencies, donors and other organizations. Nepal is considered vulnerable to the introduction or appearance of avian influenza due to: the large numbers of migrating birds, natural carriers of the virus, that rest within and pass through the country; the widespread traditional practice of mixed animal farming; cross-border importation of both eggs and chickens; and both a large poultry industry and poultry population.

In Nepal bird flu may have disastrous social and economic consequences, as the poultry industry represents close to 10 percent of the Agriculture GDP and gives direct employment to about 65,000 people across the country. Furthermore, nearly three in every five farm households keep poultry and or other domesticated birds and use the produce for extra income or family consumption.

In a scenario of uncontrolled poultry outbreaks a substantial proportion of the population would then be exposed to the risk of infection, as the virus has proven to have the capacity to cross the species barrier and infect humans occasionally, producing a severe form of influenza with high mortality.

The WHO has warned that the current uncontrolled avian influenza outbreaks in several countries and the continuous contact of human populations with the virus, may lead to its adaptation to humans and potentially to efficient human-to-human transmission. If this was to happen, and the capacity to detect and control were insufficient, large outbreaks and epidemics might occur, eventually leading to an influenza pandemic of incalculable impact.

The impact that an influenza pandemic may have on Nepal is difficult to predict. It will depend on when and in which part of the world it starts, that will in turn determine how much time it leaves for preparedness.

It is estimated that in a 2-4 months time period of a first wave of transmission as many as 20-30 % of the population could be affected by the virus and that 2-3% of those affected would die. Based on these numbers, the effects in Nepal could be catastrophic. As many as 6 million people in Nepal could be ill and more than 100,000 die in a period of 8-16 weeks.

In such scenario, given the low absorptive capacity of the health care system in Nepal, many health facilities would soon find themselves overwhelmed by the sheer numbers of both outpatient visits and inpatient care. Health staff themselves would also succumb with a consequent reduction in those able to care for the sick. Medical supplies would quickly be exhausted and people would become panicked with possibilities of riots occurring as people seek medical attention or compete for critical medications.

Businesses, transportation systems, essential services as water supply, electricity, telecommunications and sanitation would also be severely affected. Supply deliveries would be hampered and shortages of food, fresh water and household goods may occur.

Public health measures to slow down and reduce rate of transmission, such as social distancing and self quarantine would be implemented. This could include closure of schools, limitation of public gatherings and restriction to travel to and from containment areas.

The scenario described could continue in waves around the globe for 2-4 months each time with perhaps more than one wave in each area.

The Nepal National Avian Influenza and Influenza Pandemic Preparedness and Response Plan (NAIIPPRP), approved by the government in March 2006, grouped activities in five broad components:

1. WHO guidelines for humanitarian agencies, May 2006

Ref: WHO/CDS/NTD/DCE/2006.2

WHO global influenza preparedness plans

The role of WHO and recommendations for national measures before and during pandemics
March 2005
WHO/CDS/CSR/GIP/2005.5

The WHO global influenza preparedness plan has been prepared to assist WHO Member States and those responsible for public health, medical and emergency preparedness to respond to threats and occurrences of pandemic influenza.

It updates and significantly revises the Influenza pandemic plan. The role of WHO and guidelines for national and regional planning published by WHO in 1999. This new plan addresses the possibility of a prolonged existence of an influenza virus of pandemic potential, such as the H5N1 influenza virus subtype in poultry flocks in Asia, which persisted from 2003 onwards.

It also makes provision for the possibility of simultaneous occurrence of events with pandemic potential with different threat levels in different countries, as was the case in 2004 with poultry outbreaks of H7N3 in Canada and H5N1in Asia.The phases of increasing public health risk associated with the emergence of a new influenza virus subtype that may pose a pandemic threat have been redefined, actions for national authorities are recommended, and measures to be taken by WHO during each phase outlined.

This should result in greater predictability of the measures to be taken by the various partners involved, including WHO, during the different phases of the pandemic, and should improve international coordination and transparency in recommended national measures. Guidance is also provided to national authorities for developing their own pandemic plans in line with these phases.This document should be used in conjunction with the WHO checklist for influenza pandemic preparedness planning published by the World Health Organization in 2005.


2. Pandemic influenza preparedness and mitigation in refugee and displaced populations



3. WHO checklist for influenza pandemic preparedness planning

2005
WHO/CDS/CSR/GIP/2005.4

During the 20th century, influenza pandemics caused millions of deaths, social disruption and profound economic losses worldwide. Influenza experts agree that another pandemic is likely to happen but are unable to say when. The specific characteristics of a future pandemic virus cannot be predicted. Nobody knows how pathogenic a new virus would be, and which age groups it would affect. The impact of improved nutrition and health care needs to be weighed against the effect of increased international travel or simultaneous health threats. The level of preparedness will also influence the economic and medical impact of the disease and the final death toll. However, even in one of the more conservative scenarios, it has been calculated that the world will face up to several 100 million outpatient visits, more than 25 million hospital admissions and several million deaths globally, within a very short period.

The objective of pandemic planning is to enable countries to be better prepared to recognize and manage an influenza pandemic. Planning may help to reduce transmission of the pandemic virus, to decrease cases, hospitalizations and deaths, to maintain essential services and to reduce the economic and social impact of an influenza pandemic.

Many countries have gained experience in pandemic planning and response through dealing with the threat or reality of severe acute respiratory syndrome (SARS) and highly pathogenic avian influenza (HPAI). Lessons learned during these outbreaks have been used when preparing the checklist, with SARS representing the first emerging infectious disease in the millennium and HPAI representing a real pandemic threat of global significance. Experience with these outbreaks has shown that there is always room for improvement in pandemic preparedness.

The checklist, prepared by the World Health Organization for the benefit of its Member States worldwide, reflects international expert opinion on the subject of influenza pandemic preparedness planning.


4. Communicable diseases control in emergencies - A field manual

WHO Outbreak Communication - Handbook for Journalist: Influenza Pandemic

WHO Outbreak Communication Guidelines




5. Communicable diseases in complex emergencies: impact and challenges

The Lancet 2004; 364(9449): 1974-1983

For personal use. Only reproduce with permission from Elsevier Ltd.
www.thelancet.com